What Can Mitt Romney Say About Health Reform?

Mitt Romney hasn’t officially filed to run for President. He has no campaign manager. He hasn’t been to first-in-the-nation Iowa so far this year. Yet at 2 p.m. ET on Thursday at the University of Michigan Cardiovascular Center in Ann Arbor, Romney will deliver a full-fledged, single-issue campaign speech. Why? You probably already know.

The structural and philosophical parallels between the universal health care reform bill signed by President Obama last year and the one Romney championed as governor of Massachusetts are apparent. The use of an individual mandate, a measure requiring almost all citizens to purchase private insurance, has become especially bedeviling for Romney, as the policy became arch heresy among Republicans and the primary target for their legal challenges to Obama’s law. It has become a widely acknowledged dilemma too, common enough knowledge to be the premise of a joke in The Onion — “Mitt Romney Haunted By Past Of Trying To Help Uninsured Sick People,” read the satiral newspaper’s headline. And the President’s political team has sought to bring as much attention to the issue as possible in order to drive a wedge between the Republican base and the man who could be Obama’s stiffest challenger in 2012. “I agree with Mitt Romney, who recently said he’s proud of what he accomplished on health care by giving states the power to determine their own health care solutions,” Obama said in a speech to governors at the White House earlier this year. “He’s right.”

It’s only just beginning. The fur won’t really start flying until Romney’s rivals for the Republican presidential nomination have a chance to publicly challenge him. They’ve tread lightly so far, but the former governor’s advisers want him to be well prepared with a carefully tested message before getting into the thick of the GOP primary. That, in part, is why Romney is giving his speech Thursday in Ann Arbor. “Doing it now before a formal announcement and before he goes to his first debate gives him a foundation to talk about what he would replace Obamacare with,” says spokesman Eric Fehrnstrom.

Whatever Romney says Thursday or in future forums, he will have to reckon with what he’s said in the past. Since arriving on the national scene, Romney has been consistent in his federalist defense of state-based individual mandates, without explicitly proposing or endorsing a similar policy on the federal level. But as the issue has returned to prominence in the run-up to his presumed 2012 campaign, opposition researchers have begun combing through his past public statements to try to find chinks in the armor. One such possible inconsistency was flagged Wednesday by the liberal blog Blue Mass Group:

In 1994, Romney told The New Republic that he would support a health reform plan authored by Republican U.S. Senator John Chafee, which included a federal individual mandate to purchase health insurance. It’s not a position he’s taken recently and Fehrnstrom is quick to point out that “Mitt has made it amply clear over the years, including during his last presidential campaign, that he opposes a federally imposed individual mandate.” But Romney has repeatedly praised state mandates, like the one he signed into law in Massachusetts, as an effective method of enforcing a “personal responsibility principle” in health care, where the high costs of caring for the recklessly uninsured aren’t shouldered by the rest of society.

“I think it’s a terrific idea,” Romney said of a state-level individual mandate on Meet the Press in December of 2007. “I think you’re going to find, when it’s all said and done, after all these states that are laboratories of democracy get their chance to try their own plans, that those who follow the path that we pursued will find it’s the best path, and we’ll end up with a nation that’s taken a mandate approach.”

It’s statements like that (and the precarious nuance required to defend a policy for most states while decrying it on the federal level) that many Republicans find totally unsatisfactory. The Wall Street Journal’s editorial page, hivemind for elite Republican opinion on health reform, issued a stinging op-ed Thursday morning in advance of Romney’s speech. “ObamaCare and the larger entitlement state may be the central question of the 2012 election,” it reads. “On that question, Mr. Romney is compromised and not credible. If he does not change his message, he might as well try to knock off Joe Biden and get on the Obama ticket.”

Most of the Ann Arbor speech will likely focus on Romney’s critiques of Democrats’ health reform law and outlines of his own proposals. According to an op-ed piece in USA Today, Romney will argue for a state-centric approach while making the perennial GOP recommendations to reform medical liability laws, promote health savings accounts and allow insurance to be sold over state lines. But the key political question is what he will say about the universal health care law he championed as governor. Will he more vigorously defend MassachusettsCare? Will he repudiate it? Will he expand, clarify or otherwise change his federalist defense?

“In politics, if you’re explaining, you’re losing,” says Mark McKinnon, a GOP strategist and former adviser to President George W. Bush. “In order to be successful, Romney’s speech needs to address this issue in such a clear and forceful way so that he can stop talking about it and move on.” But as the last few years have proved, it isn’t easy to speak clearly about his health reform dilemma. And, as the coming months will surely show, no one is yet prepared to move on.